title: Prehospital blood product transfusion by U.S. army MEDEVAC during combat operations in Afghanistan: a process improvement initiative.
abstract: U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. These transfusions were initiated from point of injury locations aboard MEDEVAC aircraft originating from one of two locations in southern Afghanistan. All flight medics executing the transfusions were qualified through a standardized and approved program of instruction, which included day and night skills validation, and a 90% or higher written examination score. There was no adverse reaction or out-of-standard blood product temperature despite hazardous conditions and elevated cabin temperatures. All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documentation of blood product units ensured that flight medic initiated transfusions were safe and effective. Research study is needed to refine the indications for prehospital blood transfusion and to determine the effect on outcomes in severely injured trauma patients.
authors.affiliation: Womack Army Medical Center, 2817 Reilly Road, Stop A, Fort Bragg, NC 28310, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Malsby
authors.forename: Jose
authors.initials: J
authors.lastname: Quesada
authors.forename: Nicole
authors.initials: N
authors.lastname: Powell-Dunford
authors.forename: Ren
authors.initials: R
authors.lastname: Kinoshita
authors.forename: John
authors.initials: J
authors.lastname: Kurtz
authors.forename: William
authors.initials: W
authors.lastname: Gehlen
authors.forename: Colleen
authors.initials: C
authors.lastname: Adams
authors.forename: Dustin
authors.initials: D
authors.lastname: Martin
authors.forename: Stacy
authors.initials: S
authors.lastname: Shackelford
mesh_terms: D055826:Afghan Campaign 2001-; D017732:Air Ambulances; D001803:Blood Transfusion / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D006801:Humans; D008887:Military Medicine / Q000592:standards*; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy